Background. The role played by the changes of the elastic properties of large arteries in the pathogenesis of hypertension has not been entirely explained yet. The aim of this study was to assess the impact of ACE inhibitors (ACE-I) and diuretics on aortic compliance in young hypertensives.
Material and methods. 56 patients (mean age 33.5 ± 3.7 years) with newly diagnosed or previously untreated mild or moderate hypertension were enrolled in the study. In all of them, ACE inhibitor or diuretic based treatment was initiated. In all patients before the treatment and at 6 months, the following measurements were performed: blood pressure and heart rate (3 times), 24-hour ABPM and pulse wave velocity of aorta. The patients were divided in to subgroups according to PWV and hypotensive therapy (HC+ACE-I, HC+diuretic, HC–ACE, HC–diuretic).
Results. Analysis of subsets with reduced aortic compliance, both HC–ACE-I and HC–diuretic, revealed significantly higher reduction (p < 0.01) of pulse pressure in subjects on ACE inhibitors as compared to diuretics (–12.4 ± 6.9 mm Hg vs. –5.7 ± 7.6 mm Hg, respectively). Pulse wave velocity changes resulting from ACE inhibitor treatment were more pronounced in reduced compliance group (HC–ACE-I) compared to normal compliance (HC+ACE-I) (delta –2.2 ± 1.1 m/s vs. –0.7 ± 0.5 ms; p < 0.001). In HC–diuretic, group pulse wave velocity reduction was higher than in the HC+diuretic group (–0.6 ± 1.0 m/s vs. –0.3 ± ± 0.7 ms; p < 0.05). In patients with reduced aortic compliance, pulse wave velocity reduction, i.e. compliance improvement, was greater in subjects receiving ACE inhibitors as compared to diuretics (DPWV –2.2 ± ± 1.0 m/s vs. –0,6 ± 1.0 m/s; p < 0.001).
Conclusions. In young patients with hypertension and normal aortic compliance, diuretic and ACE inhibitors equally reduce blood pressure. ACE inhibitors are more efficient in patients with reduced aortic compliance. ACE inhibitors improve aortic compliance in young hypertensives better than diuretic. Both ACE inhibitors and diuretic improve compliance better in subjects with reduced compliance at baseline. There seems not to be a clear rationale for choosing preferentially either tiazide diuretic or ACE inhibitor in young patients with hypertension and normal aortic compliance. However, in the case of reduced compliance, choice of ACE inhibitor is probably a better alternative.